Abstract
Purpose :
Periventricular white matter hyperintensities (PVWH) in T2-FLAIR magnetic resonance imaging (MRI) brain scans of 135 children, with and without primary concomitant strabismus (PCS) and with and without antenatal brain insult (ABI) were retrospectively studied to explore if these changes were more frequently seen in esotropia (ET) and if they were a sequelae of ABI.
Methods :
The study cohort comprised subjects with ET (Group 1, ET with ABI, n=22, 2.8±3.2 years, 14 males, Fig 1A and Group 2, ET without ABI, n=25, 5.4±3.1 years, 15 males, Fig 1B), exotropia (XT) (Group 3, XT with ABI, n=11, 4.9±6.0 years, 8 males, Fig 1C and Group 4, XT without ABI, n=29, 9.4±4.0 years, 13 males, Fig 1D) and orthotropia (OT) (Group 5, OT with ABI, n=23, 3.4±3.1 years, 14 males, Fig 1E and Group 6, OT without ABI, n=25, 7.8±4.5 years, 14 males, Fig 1F). T2-FLAIR MRI brain scans (1.5T, Siemens Symphony) were analysed for volume of the PVWH and its anatomic distribution.
Results :
All groups with ABI had significantly higher volume of PVWH lesions compared to those without ABI (Group 1 vs 2: 43.35cm3 vs 7.68cm3, p<10-5; Group 3 vs 4: 36.02cm3 vs 8.11cm3, p<10-7; Group 5 vs 6: 36.46cm3 vs 1.95cm3, p=0.002; Fig 1). Among those without ABI, ET and XT subjects had significantly higher volumes of PVWH compared to those with OT (Group 2 vs 6: 7.68cm3 vs 1.95cm3, p=0.003; Group 4 vs 6: 8.11cm3 vs 1.95cm3, p=0.001). Also, in the cohort without ABI, ET and XT had significantly higher volume of PVWH around the ventricular trigone and the occipital horns of the lateral ventricle compared to OT (Group 2 vs 6: 4.75cm3 vs 1.02cm3, p=0.002; Group 4 vs 6: 5.67cm3 vs 1.02cm3, p<10-3; arrowheads in Fig 1). No significant difference was found either in the total volume of PVWH (p=0.86) or its distributions in ET and XT without ABI (all p>0.05).
Conclusions :
PVWH were seen universally in the study population, including in neurologically and developmentally normal orthotropic children. In subjects without ABI, those with PCS (ET and XT to a similar extent) had PVWH that were significantly more in volume and had significantly different distribution compared to orthotropes. This novel clinico-radiological correlation opens newer avenues for research into the etiology of PCS.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.